title: The value of and challenges for cholera vaccines in Africa.
abstract: The 21st century saw a shift in the cholera burden from Asia to Africa. The risk factors for cholera outbreaks in Africa are incompletely understood, and the traditional emphasis on providing safe drinking water and improving sanitation and hygiene has proven remarkably insufficient to contain outbreaks. Current killed whole-cell oral cholera vaccines (OCVs) are safe and guarantee a high level of protection for several years. OCVs have been licensed for >20 years, but their potential for preventing and control cholera outbreaks in Africa has not been realized. Although each item in the long list of technical reasons why cholera vaccination campaigns have been deferred is plausible, we believe that the biggest barrier is that populations affected by cholera outbreaks are underprivileged and lack a strong political voice. The evaluation and use of OCVs as a tool for cholera control will require a new, more compassionate, less risk-averse generation of decision makers.
authors.affiliation: Menzies School of Health Research, Casuarina, Australia.
authors.forename: Lorenz
authors.initials: L
authors.lastname: von Seidlein
authors.forename: Mohammad
authors.initials: M
authors.lastname: Jiddawi
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Grais
authors.forename: Francisco
authors.initials: F
authors.lastname: Luquero
authors.forename: Marcelino
authors.initials: M
authors.lastname: Lucas
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Deen
mesh_terms: D000349:Africa / Q000453:epidemiology; D002771:Cholera / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control*; D022121:Cholera Vaccines / Q000191:economics / Q000276:immunology* / Q000600:supply & distribution; D003362:Cost-Benefit Analysis; D019353:Endemic Diseases / Q000517:prevention & control; D058872:Epidemics / Q000517:prevention & control; D006801:Humans; D032541:Mass Vaccination / Q000191:economics / Q000379:methods; D012498:Sanitary Engineering; D062205:Strategic Stockpile / Q000191:economics; D014881:Water Supply
chemical_list: D022121:Cholera Vaccines
keywords: Africa; OCV; cholera; review; vaccine